Permanent Pacemaker Implantation in Patients With Isolated Persistent Left Superior Vena Cava From a Right-Sided Approach: Technical Considerations and Follow-Up Outcome.
Alpha loop configuration
Coronary sinus
Lead dislodgement
Permanent pacemaker implantation
Persistent left superior vena cava
Journal
Cardiology research
ISSN: 1923-2829
Titre abrégé: Cardiol Res
Pays: Canada
ID NLM: 101557543
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
30
09
2018
accepted:
10
01
2019
entrez:
6
3
2019
pubmed:
6
3
2019
medline:
6
3
2019
Statut:
ppublish
Résumé
Positioning a permanent pacing wire in patients with persistent left superior vena cava (PLSVC) to right ventricle often comes as on-table surprise. It is technically demanding and therefore most of operators prefer left-sided approach. We assessed technical challenges during pacemaker implantation, and their short- and long-term outcomes among patients with isolated PLSVC from a right-sided approach. Thirty-one consecutive patients with isolated PLSVC and 93 patients with right superior vena cava (RSVC) were enrolled with syncope with sinus node dysfunction (SND) and atrioventricular (AV) block. Study was designed on the basis of nested case-control method, and therefore 1:3 proportions was the enrolment criteria to detect any difference as statistically significant as incidence of isolated PLSVC is low. Mean age of patients was 64.8 ± 10.5 years. SND was the most common indication (n = 55; 44%) followed by AV block (n = 47; 37%). Nineteen (20%) patients received tined pacing lead, while 105 (85%) had screwing lead. There was no significant difference in mean procedural time (25 ± 11 min vs. 23 ± 12 min; P = 0.24), mean fluoroscopic time (3.1 ± 2.2 min vs. 2.7 ± 2.1 min; P = 0.54), pacing parameters for atrial and ventricular leads, dislodgement rate (3.2% vs. 4.8%; P = 0.32) and follow-up duration (6.9 ± 1.3 years vs. 7.2 ± 1.1 years; P = 0.18) between two groups. Compared to patients with RSVC, those with PLSVC had alpha loop configuration for ventricular lead which was statistically significant (31 vs. 00; P = 0.002). Patients with PLSVC had alpha loop configuration for ventricular lead because of circuitous course via left mediastinum. Although pacemaker implantation through coronary sinus via isolated PLSVC from right sided-approach is technically challenging, it obtains good long-term results but needs frequent follow-up during the initial period.
Sections du résumé
BACKGROUND
BACKGROUND
Positioning a permanent pacing wire in patients with persistent left superior vena cava (PLSVC) to right ventricle often comes as on-table surprise. It is technically demanding and therefore most of operators prefer left-sided approach. We assessed technical challenges during pacemaker implantation, and their short- and long-term outcomes among patients with isolated PLSVC from a right-sided approach.
METHODS
METHODS
Thirty-one consecutive patients with isolated PLSVC and 93 patients with right superior vena cava (RSVC) were enrolled with syncope with sinus node dysfunction (SND) and atrioventricular (AV) block. Study was designed on the basis of nested case-control method, and therefore 1:3 proportions was the enrolment criteria to detect any difference as statistically significant as incidence of isolated PLSVC is low.
RESULTS
RESULTS
Mean age of patients was 64.8 ± 10.5 years. SND was the most common indication (n = 55; 44%) followed by AV block (n = 47; 37%). Nineteen (20%) patients received tined pacing lead, while 105 (85%) had screwing lead. There was no significant difference in mean procedural time (25 ± 11 min vs. 23 ± 12 min; P = 0.24), mean fluoroscopic time (3.1 ± 2.2 min vs. 2.7 ± 2.1 min; P = 0.54), pacing parameters for atrial and ventricular leads, dislodgement rate (3.2% vs. 4.8%; P = 0.32) and follow-up duration (6.9 ± 1.3 years vs. 7.2 ± 1.1 years; P = 0.18) between two groups. Compared to patients with RSVC, those with PLSVC had alpha loop configuration for ventricular lead which was statistically significant (31 vs. 00; P = 0.002).
CONCLUSIONS
CONCLUSIONS
Patients with PLSVC had alpha loop configuration for ventricular lead because of circuitous course via left mediastinum. Although pacemaker implantation through coronary sinus via isolated PLSVC from right sided-approach is technically challenging, it obtains good long-term results but needs frequent follow-up during the initial period.
Identifiants
pubmed: 30834055
doi: 10.14740/cr784
pmc: PMC6396803
doi:
Types de publication
Journal Article
Langues
eng
Pagination
18-23Déclaration de conflit d'intérêts
None.
Références
Heart. 2000 Jun;83(6):704
pubmed: 10814635
Int J Cardiol. 2002 Jan;82(1):91-3
pubmed: 11786168
Surg Radiol Anat. 2003 Jul-Aug;25(3-4):315-21
pubmed: 12898196
Int J Cardiol. 1992 Aug;36(2):242-3
pubmed: 1512068
Vasc Endovascular Surg. 2005 Jan-Feb;39(1):109-11
pubmed: 15696254
Surg Radiol Anat. 2006 May;28(2):206-10
pubmed: 16402153
Cardiovasc Ultrasound. 2006 Jan 26;4:6
pubmed: 16438718
Pacing Clin Electrophysiol. 2006 Oct;29(10):1181-2
pubmed: 17038152
Srp Arh Celok Lek. 2010 Jan-Feb;138(1-2):85-7
pubmed: 20422915
Indian Pacing Electrophysiol J. 2011 Feb 07;10(12):551-5
pubmed: 21358800
Neth Heart J. 2006 Aug;14(7-8):255-257
pubmed: 25696649
Heart Views. 2015 Jul-Sep;16(3):107-10
pubmed: 27326354
J Cardiol Cases. 2012 Jan 20;5(2):e122-e124
pubmed: 30532919
Am Heart J. 1986 Sep;112(3):621-2
pubmed: 3751875
Am J Cardiol. 1980 Jan;45(1):117-22
pubmed: 7350758